	Electronic signature solutions for wherever business takes you.

SIGVALID AUTHORIZATION FORM

You may request authorization to be licensed for Topaz SigValid Software. To request authorization, please enter your information below. If you do not enter a valid corporate e-mail address or receive a confirming e-mail, your tablet will not be authorized to use SigValid. Please contact the factory if you have questions.

* denotes required field

*Company/Organization:**
*First Name:**
*Last Name:**
*Street Address:**
*City:**
*State/Province:**
*Zip/Postal Code:**
*Country:**
*E-Mail:**
*Phone Number:**	10 digits with no ( ) or -
Extension:
*Tablet Model:**
*Serial Number:**	under the barcode, between * symbols
Reason for Interest:*	Evaluation Development Roll-out
*Rollout Quantity:**
Additional Comments or Special Instructions: